Basic Information
| Provider Information | |||||||||
| NPI: | 1730434788 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NEVADA BEHAVIORAL HEALTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 336390 | ||||||||
| Address2: | |||||||||
| City: | NORTH LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890336390 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7022076790 | ||||||||
| FaxNumber: | 7022076791 | ||||||||
| Practice Location | |||||||||
| Address1: | 2285 RENAISSANCE DR STE E | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891196752 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7022076790 | ||||||||
| FaxNumber: | 7022076791 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2012 | ||||||||
| LastUpdateDate: | 07/16/2012 | ||||||||
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| AuthorizedOfficialLastName: | HILL | ||||||||
| AuthorizedOfficialFirstName: | MARVIE | ||||||||
| AuthorizedOfficialMiddleName: | LEE | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7023511072 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | NV20121430852 | NV | Y | Agencies | Community/Behavioral Health |
No ID Information.